Provider Demographics
NPI:1558336412
Name:STUART A TERRY MD PA
Entity Type:Organization
Organization Name:STUART A TERRY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ODAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALSHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-222-2154
Mailing Address - Street 1:1100 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4701
Mailing Address - Country:US
Mailing Address - Phone:210-222-2154
Mailing Address - Fax:210-227-6056
Practice Address - Street 1:1100 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4701
Practice Address - Country:US
Practice Address - Phone:210-222-2154
Practice Address - Fax:210-227-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1771207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084961401Medicaid
TX084961401Medicaid
TX00R92WMedicare PIN